Osteoarthritis and the rule of halves

Sheikh, L., Nicholl, B.I. , Green, D.J., Bedson, J. and Peat, G. (2014) Osteoarthritis and the rule of halves. Osteoarthritis and Cartilage, 22(4), pp. 535-539. (doi: 10.1016/j.joca.2014.02.006)

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<b>Background</b> Symptomatic osteoarthritis poses a major challenge to primary health care but no studies have related accessing primary care ("detection"), receiving recommended treatments ("treatment"), and achieving adequate control ("control").<p></p> <b>Objective</b> To provide estimates of detection, treatment, and control within a single population adapting the approach used to determine a Rule of Halves for other long-term conditions.<p></p> <b>Setting</b> General population.<p></p> <b>Participants</b> 400 adults aged 50+ years with prevalent symptomatic knee osteoarthritis.<p></p> <b>Design</b> Prospective cohort with baseline questionnaire, clinical assessment, and plain radiographs, and questionnaire follow-up at 18 and 36 months and linkage to primary care medical records.<p></p> <b>Outcome measures</b> "Detection" was defined as at least one musculoskeletal knee-related GP consultation between baseline and 36 months. "Treatment" was self-reported use of at least one recommended treatment or physiotherapy/hospital specialist referral for their knee problem at all three measurement points. Pain was "controlled" if characteristic pain intensity <5 out of 10 on at least two occasions.<p></p> <b>Results</b> In 221 cases (55.3%; 95%CI: 50.4, 60.1) there was evidence that the current problem had been detected in general practice. Of those detected, 164 (74.2% (68.4, 80.0)) were receiving one or more of the recommended treatments at all three measurement points. Of those detected and treated, 45 (27.4% (20.5, 34.3)) had symptoms under control on at least two occasions. Using narrower definitions resulted in substantially lower estimates.<p></p> <b>Conclusion</b> Osteoarthritis care does not conform to a Rule of Halves. Symptom control is low among those accessing health care and receiving treatment.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Nicholl, Dr Barbara
Authors: Sheikh, L., Nicholl, B.I., Green, D.J., Bedson, J., and Peat, G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:Osteoarthritis and Cartilage
Publisher:Elsevier Ltd.
ISSN (Online):1522-9653
Copyright Holders:Copyright © 2014 Osteoarthritis Research Society International
First Published:First published in Osteoarthritis and Cartilage 22(4):535-539
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher
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